Provider Demographics
NPI:1750333050
Name:STEWART, ADA (MD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2623
Mailing Address - Country:US
Mailing Address - Phone:803-799-8407
Mailing Address - Fax:803-252-9070
Practice Address - Street 1:1520 LAUREL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2623
Practice Address - Country:US
Practice Address - Phone:803-799-8407
Practice Address - Fax:803-252-9070
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC043Medicaid
SCFQC030Medicaid
SCI06199Medicare UPIN
SCFQC030Medicaid
SCFQC043Medicaid
SC7131Medicare PIN
WI421832Medicare Oscar/Certification